The Peak-End Rule (PER) occurs when an event is remembered more by what happens at the peak or the end than at any other point in the encounter.

The Nobel Prize winner Daniel Kahneman and his colleagues have shown that how we remember our past experiences is almost entirely determined by 2 things:

1. The average of how the experience felt at its peak (best or worst)
2. How the experience felt when it ended

The PER is how humans summarize their experiences. We rely on that summary later to remind ourselves of how an experience felt, affecting our decisions about having that experience again. For example, if your 18th birthday was filled with laughter but ended with a fistfight, your memory of that event will likely skew to the worst part of the experience and how you felt when the party was over.

Another example of the PER event might be returning from a vacation and finding that your luggage didn’t arrive. This negative experience can ruin your entire vacation by ending with this inconvenience.

Kahneman noted that human memory seldom records a series of events accurately, thus giving evidence of the influence of the PER in our memory processes. The study asked participants to endure an uncomfortable experimental condition, where individuals were subjected to 2 versions of the same unpleasant experience. The experiment’s first trial asked study participants to submerge their hands in 14 °C water for 60 seconds. The second group placed their hands in the ice water for 60 seconds, and they were asked to keep their hand submerged for 30 additional seconds while the water temperature was raised to 18 °C. After these 2 trials, participants were asked which option of the trial they would choose to repeat. Study subjects were more willing to repeat the second trial despite the prolonged exposure to uncomfortable temperatures. They concluded that this happened because subjects chose the long trial simply because they liked the memory of it better than the alternative.

The PER has been prevalently studied in medical procedures and has suggested that patients prefer longer medical procedures with decreased discomfort rather than uncomfortable, shorter procedures. The PER revealed that a painful medical treatment is likely less aversive if relief from the pain is gradual than if relief is abrupt. This would certainly apply to office cystoscopy using topical anesthesia.¹

Other examples that can be adopted by a urologist include:

If you have serious news regarding the patient’s medical condition or prognosis, offer the negative news first and end with something positive. For example, if you are delivering a prostate cancer diagnosis, state that first and end with the news that the condition is treatable and that you are committed that the patient will not experience significant pain or discomfort.

Another pain point that needs to occur before the end of the communication between the doctor and the practice is the financial transaction that commonly occurs at the end of the doctor-patient encounter. I suggest you reverse the payment process and tell the patient about their deductibles, copays, and the anticipated visit cost. You should also collect the money before the patient is escorted to the exam room. Also, don’t encourage the receptionist to ask, “Would you like to take care of your balance today?” The receptionist will usually receive a response that translates to “no.” Instead, the receptionist might ask, “Will you pay your balance by check or credit card?” This verbiage is more likely to have a better response rate.

You and your staff can practice the PER with a gesture or a compliment. The easiest method for your staff is to use the patient’s name at the end of their office visit. We all like the sound of our own names, and patients will feel special if we use their names before they exit the practice.

Bottom line: The PER applicability is truly amazing. Imagine how much more successful you would be if you could ensure that your patient left every interaction feeling grateful and happy. Make it a priority to apply the PER and end all your interactions positively. After all, that’s what people remember, recall, and savor.